Organization
PHYSIOEDGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AL WYNNE QUERUBIN GESITE P.T. (OWNER)
(404) 771-0554
Entity
Organization
Contact information
Practice address
670 NORTH AVE NW, SUITE 201, MARIETTA, GA 30060-1100
(770) 792-8081
(770) 792-8083
Mailing address
223 MILLSTONE PKWY, WOODSTOCK, GA 30188-6139
(404) 771-0554
(770) 792-8083
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
03/06/2008
Last updated
03/23/2012
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